【摘要】：高血壓是冠心病、腦卒中、心衰、腎臟疾病及大動(dòng)脈和周圍動(dòng)脈疾病的主要危險(xiǎn)因素之一。我國(guó)人群高血壓患病率呈逐年增長(zhǎng)態(tài)勢(shì),如何有效控制血壓,保護(hù)靶器官損傷是現(xiàn)代醫(yī)學(xué)的一個(gè)挑戰(zhàn)。神經(jīng)-內(nèi)分泌系統(tǒng)的紊亂,在高血壓病發(fā)生發(fā)展過(guò)程中具有重要作用,其中以腎素-血管緊張素-醛固酮系統(tǒng)(RAAS)最為顯著。血管緊張素Ⅰ轉(zhuǎn)化酶抑制劑(ACEI)類藥物可通過(guò)阻斷ACE酶抑制AAS過(guò)度激活發(fā)揮降壓療效。臨床研究表明,ACEI對(duì)患者具有良好的靶器官保護(hù)和心血管終點(diǎn)事件預(yù)防作用。但ACEI類降壓藥物存在刺激性干咳、血鉀升高、血管性水腫等副反應(yīng),在一定程度上限制其應(yīng)用。高血壓病屬中醫(yī)“風(fēng)眩”、“眩暈”的范疇,“肝腎陰虛、肝陽(yáng)上亢”是其主要發(fā)病機(jī)理。我院陳可冀院士等對(duì)高血壓病進(jìn)行系統(tǒng)研究,在長(zhǎng)期臨床實(shí)踐的基礎(chǔ)上組成清肝熱、平肝陽(yáng)、益肝腎的清眩降壓湯,應(yīng)用臨床幾十年,顯示有良好作用。我們臨床觀察發(fā)現(xiàn),應(yīng)用ACEI類藥物患者雖可使血管緊張素轉(zhuǎn)換酶(ACE)得到抑制(低于正常水平),但部分患者血壓控制并不理想。為此,我們提出如下問(wèn)題：(1)ACE水平是否越低越好,更低的ACE水平是否可獲得更好的血壓控制?(2)如果ACE水平不是越低越好,血壓控制水平與RAAS相關(guān)激素水平存在什么樣的關(guān)系?(3)清眩降壓湯具有調(diào)和血脈、平肝潛陽(yáng)等作用,其療效是否與RAAS相關(guān)激素水平相關(guān)?圍繞上述問(wèn)題,我們進(jìn)行如下研究：研究一、高血壓患者ACEI治療后RAAS激素水平與血壓水平相關(guān)性的研究目的：研究ACEI治療后高血壓患者RAAS激素水平與血壓水平相關(guān)性。方法：本研究為回顧性研究,納入206例中、低危的Ⅰ、Ⅱ級(jí)服用ACEI類藥物1周以上的門診或住院高血壓患者,根據(jù)血壓調(diào)控的水平分為5組,填寫CRF表,收集患者一般資料、24小時(shí)動(dòng)態(tài)血壓、血管緊張素轉(zhuǎn)換酶、腎素、血管緊張素Ⅱ、醛固酮等RAAS相關(guān)激素檢測(cè)值,比較各組血管緊張素轉(zhuǎn)換酶、腎素、血管緊張素Ⅱ、醛固酮值的差異。然后,跟據(jù)血壓水平將此206例患者分為控制達(dá)標(biāo)組(140/90mmHg)和控制未達(dá)標(biāo)組(≥140/90mmHg),統(tǒng)計(jì)兩組血管緊張素轉(zhuǎn)換酶、腎素、血管緊張素Ⅱ、醛固酮的95%的置信區(qū)間并進(jìn)行分析。結(jié)果：血壓控制達(dá)標(biāo)組血管緊張素轉(zhuǎn)換酶、腎素檢測(cè)值與控制未達(dá)標(biāo)組比較無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),而血管緊張素Ⅱ、醛固酮值均低于控制未達(dá)標(biāo)組(P0.05)；血壓控制未達(dá)標(biāo)組,隨血壓升高,血管緊張素Ⅱ、醛固酮值也呈明顯升高趨勢(shì)(P0.05)。血壓控制達(dá)標(biāo)組血管緊張素Ⅱ、醛固酮值的95%置信區(qū)間分別為[3.99,7.14]、[178.9,265.1]。結(jié)論：血管緊張素Ⅱ和醛固酮值可作為中、低危的Ⅰ、Ⅱ級(jí)高血壓患者服用ACEI藥物血壓控制的參考指標(biāo)。血管緊張素Ⅱ和醛固酮值分別在[3.99,7.14]和[178.9,265.1]范圍內(nèi)的患者血壓控制水平明顯優(yōu)于區(qū)間之外患者血壓水平。研究二、清眩降壓湯對(duì)肝陽(yáng)上亢型高血壓病的臨床療效觀察及機(jī)制探討目的：觀察清眩降壓湯對(duì)中、低危的Ⅰ、Ⅱ級(jí)肝陽(yáng)上亢型高血壓患者的療效。從血管緊張素轉(zhuǎn)換酶、腎素、血管緊張素Ⅱ、醛固酮等RAAS相關(guān)激素水平與血壓的關(guān)系探討其降壓機(jī)制。方法：本研究為前瞻性開(kāi)放隨機(jī)對(duì)照研究,將172例中、低危的Ⅰ、Ⅱ級(jí)肝陽(yáng)上亢型高血壓患者采用簡(jiǎn)單隨機(jī)化方法分為治療組和對(duì)照組各86例。對(duì)照組口服福辛普利,治療組在福辛普治療基礎(chǔ)上聯(lián)合清眩降壓湯治療,分別于治療后1周、2周比較兩組的血壓、谷峰值、RAAS相關(guān)激素水平、療效、中醫(yī)癥候積分、副反應(yīng)及研究一提出的血管緊張素Ⅱ和醛固酮的95%置信區(qū)間的人數(shù)。結(jié)果：治療1周,治療組和對(duì)照組24小時(shí)平均血壓、血管緊張素Ⅱ、醛固酮水平均較治療前明顯降低(P0.05),血管緊張素轉(zhuǎn)換酶、腎素值變化雖有降低趨勢(shì),但無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)；兩組血管緊張素轉(zhuǎn)換酶、腎素、血管緊張素Ⅱ、醛固酮等tAAS相關(guān)激素值及谷峰值、總有效率、中醫(yī)癥候積分比較無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。治療2周,治療組和對(duì)照組24小時(shí)平均血壓、血管緊張素Ⅱ、醛固酮水平較治療1周有進(jìn)一步降低(P0.05),腎素、血管緊張素轉(zhuǎn)換酶值變化無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)；治療組24小時(shí)平均血壓、日間收縮壓和血管緊張素Ⅱ、醛固酮水平較對(duì)照組有明顯降低(P0.05)；治療組的谷峰值、總有效率、中醫(yī)癥候積分、副反應(yīng)、血管緊張素Ⅱ和醛固酮的95%置信區(qū)間的人數(shù)明顯優(yōu)于對(duì)照組(P0.05)。結(jié)論：清眩降壓湯聯(lián)合ACEI類藥物較單用ACEI類藥物對(duì)中、低危的Ⅰ、Ⅱ級(jí)肝陽(yáng)上亢證高血壓患者有更好的降壓療效,治療組在血管緊張素Ⅱ、醛固酮值的95%置信區(qū)間的人數(shù)明顯多于對(duì)照組,進(jìn)一步支持研究一提出的血管緊張素Ⅱ、醛固酮值的95%置信區(qū)間[3.99,7.14]、[178.9,265.1]可作為理想血壓的生化值的參考。
[Abstract]:Hypertension is one of the main risk factors for coronary heart disease, stroke, heart failure, kidney disease and arterial and peripheral arterial disease. The prevalence of hypertension in Chinese population is increasing year by year, and how to control blood pressure effectively and to protect target organ damage is a challenge in modern medicine. The disorder of the neuroendocrine system plays an important role in the development of hypertension, in which the renin-angiotensin-aldosterone system (RAAS) is the most significant. Angiotensin I converting enzyme inhibitor (ACEI) can be used to block ACE enzyme to inhibit the activation of AAS. The clinical study shows that ACEI has good target organ protection and cardiovascular end event prevention effect on patients. But the ACEI antihypertensive drugs have the effects of stimulating dry cough, increasing blood potassium and angioedema, and limiting the application to a certain extent. The essential hypertension belongs to the "wind daze" and "Vertigo" of Chinese medicine, and the "yin deficiency of liver and kidney and hyperactivity of liver yang" is its main pathogenesis. In the long-term clinical practice, the Chinese Academy of Sciences, the academician of the Chinese Academy of Sciences, made a systematic study of the hypertension, and made up the Qingxuan blood-lowering soup with the functions of clearing liver heat, calming the liver-yang and benefiting the liver and the kidney on the basis of long-term clinical practice, and has good effect in the clinical decades. Our clinical observations suggest that the application of ACEI in patients with ACEI can inhibit the angiotensin-converting enzyme (ACE) (below the normal level), but the control of blood pressure in some patients is not ideal. For this reason, we have the following questions: (1) whether the lower the ACE level is, and whether the lower ACE level is available for better blood pressure control? (2) What is the relationship between the blood pressure control level and the RAAS-related hormone level if the ACE level is not the lower the lower the lower the ACE level is? (3) Qingxuan Blood-lowering Decoction has the effects of regulating blood vessel, calming liver and suppressing yang, and is related to the level of RAAS-related hormone. The purpose of this study was to study the relationship between the level of RAAS and the level of blood pressure in the patients with high blood pressure (ACEI) after ACEI in the study of the relationship between the level of RAAS and the level of blood pressure in the patients with high blood pressure after ACEI treatment. Methods: This study was a retrospective study. In 206 cases, patients with low-risk 鈪，

本文編號(hào)：2487459